AccountId: 011433970860
ContactId: 96822943-0026-46f5-bed6-f2f6ada1bc03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 587260 ms
Total Talk Time (AGENT): 329670 ms
Total Talk Time (CUSTOMER): 175375 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/96822943-0026-46f5-bed6-f2f6ada1bc03_20250129T19:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. With whom am I speaking and how may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. This is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And a good call back number for you?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. And what may I help you with today?
[CUSTOMER][NEUTRAL] Everything.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, um,
[CUSTOMER][NEUTRAL] I had my surgery back in August.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I was trying to do the paperwork and it's like,
[CUSTOMER][NEGATIVE] Too, too, too much for me to understand at the time.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there anybody
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Is there anybody in the [PII] area that can sit down with me and help me?
[AGENT][NEGATIVE] Uh, unfortunately, no, ma'am.
[AGENT][NEUTRAL] Um, I can tell you what you need to file your claim over the phone. I can go over that with you. What is your policy number?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I don't have it. I'm here at work and my paperwork's at home.
[AGENT][NEUTRAL] OK, no, no problem. Let me get to a screen where I can look it up by your social, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is your social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Thank you for that information.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And what is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your physical mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the last piece of verification is your email address we have for you on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for verifying all that information. So this is a cancer policy and of course you know that, and I'm showing that the policy lapsed. Let's see, wait a minute, let me see if you have a.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Wait a minute.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I'm showing your policy lapsed on [PII], so you're trying to file a claim prior to that date?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Why did it?
[CUSTOMER][POSITIVE] I renewed it.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Um, that's the customer service. I will have to get you over to customer service for that, ma'am. OK? But, but let's, yeah, let's talk about how to file a claim. So to file a claim, this policy will consider malignant diagnosis of cancer, OK?
[CUSTOMER][NEUTRAL] OK, let's let's do the other first.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So we need the pathology report that diagnosed you with a malignant diagnosis of cancer.
[CUSTOMER][NEUTRAL] OK, um, malignant one.
[AGENT][NEUTRAL] Mhm. So the pathology report, so the pathology report that diagnosed you with cancer. It's just, you know, this policy is only gonna consider a malignant cancer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And, and so I'm, I'm going slow so you can write this down. You need to file a cancer claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The claim form, do you already have one?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, that claim form is located at [PII].
[CUSTOMER][NEUTRAL] Public like
[AGENT][NEUTRAL] Uh-huh. P U B uh-huh. P U B L I C.
[CUSTOMER][NEUTRAL] Everybody probably.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You will, you will click on claims and forms.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then you're gonna go to the
[CUSTOMER][NEUTRAL] Is it [PII] I'm sorry, [PII]?
[AGENT][POSITIVE] [PII], that is correct.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Click on claims and forms.
[AGENT][NEUTRAL] And locate the cancer claim form and you have to print it and download it. You cannot fill it out online, OK?
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Alright, and let me see what type of benefits you have under here.
[AGENT][NEUTRAL] One moment while I pull your policy to see what else you may need to turn in. Have you had any radiation or chemotherapy?
[CUSTOMER][POSITIVE] Um, no, I've been, I was blessed because
[CUSTOMER][NEUTRAL] Oh, I was diagnosed. They did find, you know, they did all the tests and everything and the dye came back very colorful, but my surgeon got it all.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, well, wonderful, that's one.
[CUSTOMER][NEUTRAL] No, here's, here's, yeah, here's the clicker. I went in for a um a, a CAT scan because of the surgery, I broke two ribs.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they wanted to make sure. Well, when they did, they found another tumor at the bottom of my lungs.
[AGENT][POSITIVE] OK, sorry to hear that. OK.
[CUSTOMER][NEUTRAL] And it is what it is.
[AGENT][NEUTRAL] Oh yeah, so let me get to this policy, one moment.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] All right. So, the biopsy that was performed, which is what they do um to determine whether or not you have cancer, you need an itemized bill from the surgeon.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] With procedure codes.
[AGENT][NEUTRAL] Dates of service.
[AGENT][NEUTRAL] And charge amounts mhm.
[CUSTOMER][NEUTRAL] OK, hang on a minute.
[CUSTOMER][NEUTRAL] Receipt code date of service.
[AGENT][NEUTRAL] Dates of service and charge amounts.
[AGENT][NEUTRAL] Now, anytime we ask you for an itemized bill, that's what you'll need on the itemized bill procedure codes, dates of service and charge amounts. You'll need an itemized bill for the facility where you were at to have that biopsy performed.
[AGENT][NEUTRAL] And any surgery to remove. So any surgery you've had, the biopsy is considered surgery. If they went back in and had to remove, that's the surgery. You need itemized bills for each one of those dates and the facility, and for the facility, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see here. I'm just looking at your benefits. If the facility was more than 50 miles going one way from your home, then you need to submit the physical address for us to calculate transportation, but it has to be more than 50 miles one way, not total, one way going and one way coming back, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Uh, we're good on that one.
[AGENT][NEUTRAL] OK. Well, those are your benefits. That, that's, that's the benefits, OK?
[CUSTOMER][NEUTRAL] OK. So, I don't have to, I have to tell them when it was found or approximately what month or whatever.
[AGENT][NEUTRAL] And that's, mhm.
[AGENT][NEUTRAL] You don't have, you don't have to tell us anything but submit the information that I just gave you for review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We'll be able to determine all that based off of the pathology report. We'll be able to see all dates we need to see. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good to me.
[AGENT][NEUTRAL] Alright, now do you have any other claims questions?
[CUSTOMER][NEUTRAL] Mm, oh, if I had to do a follow up because I have to do a follow up on a CT scan.
[AGENT][NEUTRAL] OK, so your policy does not have, let me go back and look at it and make sure.
[AGENT][NEUTRAL] Your policy does not have an imaging benefits, so we will not consider any CTs or MRI's or PETs, any kind of diagnostic follow up testing, OK? That's not covered. Mhm. All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, is there anything else I can help you with before I get you to customer service?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] All right, Ms. [PII]. Well, you take care of yourself. Thank you for calling APL today. It was a pleasure speaking with you. And one moment while I get you to the next representative, OK? You have a good day. Hold, hold on.
[CUSTOMER][POSITIVE] OK. Right, thank you. You as well.
[AGENT][POSITIVE] You, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Sing.
[CUSTOMER][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII] in the customer service department. How may I help you?
[AGENT][NEUTRAL] Hi, [PII]. This is [PII] in the cancer department. I have an insured on the line. Let me know when you're ready for her policy number.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] 121
[AGENT][NEUTRAL] 9885, Miss [PII].
[AGENT][NEUTRAL] I've already verified all her information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Her callback number is [PII].
[AGENT][NEUTRAL] [PII], and the reason she's calling is because I let her know that this policy lapsed. She said she don't know how it lapsed she paid the premium.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, it's that one of those policies that had to be ported and if she didn't respond, she didn't get ported.
[AGENT][NEUTRAL] That's probably what happened. Yeah, that's probably what happened.
[CUSTOMER][POSITIVE] Yeah, um, but send her to me and I'll let her know. Thank you.
[AGENT][POSITIVE] OK, you have a good 11 moment, OK?
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] I have Ms. [PII] on the line in customer service. She's gonna further assist you OK? Have an awesome rest of your day.
[CUSTOMER][POSITIVE] OK thank you you as well.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Hi, Ms. [PII]